Pharmacy Groups Balk at Supplying Lethal Injection Drugs

A leading association for U.S. pharmacists adopted a policy Monday that discourages its members from providing drugs for use in lethal injections — a move that could make carrying out such executions even harder for states with the death penalty. Death-penalty states scrambling to find drugs for lethal injections are facing a new hurdle: two groups that represent compounding pharmacists have told their members to stop making the killer cocktails.

The new guidelines could make it tough for death penalty states, like Texas, that have been looking at made-to-order execution drugs from compounding pharmacies as the answer to a nationwide shortage of execution drugs. The declaration approved by American Pharmacists Association delegates at their annual meeting held in San Diego this year says the practice of providing lethal-injection drugs is contrary to the role of pharmacists as health care providers.

The move by the association, which has about 62,000 members, sets out ethical standards for the profession but has no authority to halt the activities of the main suppliers of drugs for executions — lightly regulated compounding pharmacies that can mix chemicals. Pharmacists now join doctors and anesthesiologists in having national associations with ethics codes that restrict credentialed members from participating in executions. “Now there is unanimity among all health professions in the United States who represent anybody who might be asked to be involved in this process,” said association member Bill Fassett, who voted in favor of the policy. He notes that the new policy brings the APA in line with policies held by the American Medical Association, the American Nurses Association and the American Board of Anesthesiology. But now the compounded version is also becoming difficult to come by, with most pharmacists reluctant to expose themselves to possible harassment by death-penalty opponents.

Increasingly, pharmacies have been tapped by some states to supply medicines for executions as a growing number of drug makers restrict the use of the mediations. The AP adds: “Texas’ prison agency scrambled this month to find a supplier to replenish its inventory, then found a supply from a compounded pharmacy it won’t identify. At least nine drug makers have formally taken this step, according to Reprieve, an advocacy group based in the U.K. that has been pressuring companies to withhold their medicines for this purpose. Also this month, an execution in Georgia was put off when prison authorities questioned the appearance of the compounded pentobarbital they planned to use. “After a troubling use of a two-drug method last year, Ohio said it will use compounded versions of either pentobarbital or sodium thiopental in the future, though it doesn’t have supplies of either drug and hasn’t said how it will obtain them. All executions scheduled this year were pushed to 2016 to give the state more time to find the drugs.” The APhA represents some 62,000 practicing pharmacists, pharmaceutical scientists, student pharmacists and pharmacy technicians.

The big manufacturers of the chemicals that were used in executions for years have stopped selling their wares to correctional systems under pressure from anti-death penalty activists. That has forced states to turn to compounding pharmacies for specialty orders — but their products are not FDA-approved and critics have expressed concern about the sterility and quality of the drugs.

Currently, pharmacists are permitted by law to dispense medications for executions if a licensed doctor writes a legitimate prescription, according to Carmen Catizone, the executive director of the National Association of Boards of Pharmacy. There is no indication that any state legislature is considering a change to its regulations, but at the time of the IACP policy change last week, he noted that new policy statements may attract attention from state boards, given ongoing controversy over executions. “Any statement from any organization will get looked at,” APA chief strategy officer Mitch Rothholz said. Lawyers for condemned inmates have argued — largely without success — that made-to-order injections could contain shoddy drugs and cause an excruciating death.

Compounding pharmacies exposed as execution suppliers have also been targeted by protests, and several have decided they would not sell to prisons any more. Andre Cole faces execution on April 14 for fatally stabbing his ex-wife’s boyfriend, and Kimber Edwards on May 12 for hiring a hitman to kill his ex-wife.

In response, a wave of states have enacted secrecy laws that protect the anonymity of the pharmacies, and anyone else involved in the execution process. Scheidgger said he expects that at least a few compounding pharmacies will buck the trade groups and continue to sell their products to prisons until a new source is found.

Fassett, a professor emeritus of pharmacy law and ethics at Washington State University, said the united front by health professionals might force people to finally face the death penalty’s harsh realities. “It’s like we’re not really executing.